Abstract:

Background
Though condom use is a proven effective method to prevent Human Immunodeficiency Virus (HIV) transmission, there is limited or no documented information about condom use practices among HIV-infected clients in southwestern Uganda. HIV transmission continues to occur daily and knowledge about the level of consistent condom use, the reasons for not using condoms among those who do not use them consistently and the factors associated with consistent condom usage among HIV positive clients is essential in designing strategies for prevention of HIV transmission.
Objectives
To ascertain the proportion of adult HIV positive clients who used condoms consistently, determine factors associated with consistent condom use and to explore the reasons for not using condoms consistently.
Methods
A cross sectional study was conducted among consenting HIV positive adult clients attending Mbarara Regional Referral Hospital (MRRH) HIV clinic. Quantitative and qualitative methods were used in this study. Quantitatively, an interviewer administered questionnaire was used. This was implemented by trained and experienced research assistants. The reasons for not using condoms consistently were assessed using both quantitative and qualitative methods. Descriptive statistical methods were used to analyze data on clients’ social demographic characteristics, condom use and its frequency. Bivariate analysis and multivariate logistic regression modeling were used to assess factors associated with consistent condom use. Qualitatively, in-depth interviews were conducted and voice recorded for data capture, storage and analysis. Content data analysis was done to summarize the reasons for not using condoms. 13
Results
total of three hundred and eighty six (386) adult HIV positive clients attending the MRRH HIV clinic were interviewed. The majority of respondents (n=197, 51%) were male, and 87% (336/386) were taking antiretroviral therapy (ART). Nearly half (n=184, 47.7%) reported having sex at least once a week. Overall, about a third (32.9%) of the clients reported consistent condom use within six months prior to the interview. Consistent condom use was higher among male clients at 41.2% compared to that among female clients at 24.3%. The odds of consistent condom use were significantly higher when the sexual partner was HIV negative (OR= 1.8; 95% CI 1.06 - 3.07), compared to when partner was HIV positive. The odds of consistent condom use were also significantly higher among those who had attended health education sessions at the clinic; for one session (OR= 2.8; 95% CI 1.30 - 5.79 ) , for two sessions (OR =3.7 ; 95% CI 1.98 - 6.79 ), for three sessions (OR= 3.3; 95% CI 1.66 - 6.49 ), for four sessions and above (OR= 51.6 ;95% CI 5.66 - 470.27), compared to those who had not attended the sessions. The commonest reasons for not using condoms consistently were sexual partner refusal (41.1%), clients not wanting to use condoms (19.8%) and lack of condoms at time of having sex (11.7%).
Conclusion and Recommendations
Consistent condom use among adult HIV positive clients attending MRRH HIV clinic was very low. Overall, only a third of the clients used condoms consistently. Consistent condom use was higher among male clients. Factors associated with increased odds of consistent condom use were having attended health education sessions at the clinic and having sexual partners who were HIV negative. Strategies that can help to increase consistent condom usage among HIV positive clients may include: frequent routine health education about consistent condom use, distribution of condoms to HIV positive clients, and couple counselling and testing.

Description:

A thesis submitted in partial fulfillment of the requirements for the award of the Masters Degree in Public Health of Makerere University